Answers to the CME Quiz for "Optimal Nutrition for Improved Twin Pregnancy Outcome" by William Goodnight, MD, and Roger Newman, MD (Obstet Gynecol 2009;114[5])

1. The daily recommended caloric intake for women with a normal body mass index (BMI; 18.5-24.9) with twins is:

C. 40-45 Kcal/day

2. The physiologic changes in blood volume associated with a twin gestation result in which of the following changes?

D. Increased concentrations of fat-soluble vitamins

3. The cumulative increase in resting energy expenditure found in twin pregnancies can result in what percentage increase in caloric requirements for the mother?

D. 40%

4. The relatively larger placental mass in multiple gestations results in an increase in placental steroid and hormone production, which places the mother at an increased risk for:

B. Ketonemia

5. To achieve the greatest likelihood of euglycemia, it has been recommended that the patient with a twin gestation should consume a diet that contains what percentage of carbohydrates?

B. 40%

6. For women with a normal prepregnancy body mass index (BMI; 18.5–24.9), studies have demonstrated that optimal twin pregnancy outcome (defined as two living infants, each weighing more than 2,500 grams, born after 37 weeks of estimated gestational age, with 5-minute Apgar scores greater than 7) was associated with a maternal weight gain of:

D. 20 kg (44 lb)

7. The maternal weight gains that appear to have the greatest impact on fetal growth and ultimate birth weight in twin gestations occur:

C. During the second trimester

8. When compared to Caucasians, the amount of sun exposure needed to convert vitamin D to the active metabolite 1,25-dihydroxyvitamin D that African Americans require is:

E. Five times as much

9. When compared to singleton pregnancies, twin gestations have a rate of iron deficiency that is approximately:

E. Four times as much

10. By the second month of life, nursing mothers of twins require an increase in daily caloric intake that approximates:

E. 1,200-1,500 Kcal/day

ACCME Accreditation: The American College of Obstetricians and Gynecologists (ACOG) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. (Continuing medical education credit for "Optimal Nutrition for Improved Twin Pregnancy Outcome" will be available through November 2012.)

AMA PRA Category 1 Credit^TM and ACOG Cognate Credit: The American College of Obstetricians and Gynecologists (ACOG) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM or up to a maximum of 2 Category 1 ACOG cognate credits. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Statement: Current guidelines state that continuing medical education (CME) providers must ensure that CME activities are free from the control of any commercial interest. All authors, reviewers, and contributors have disclosed to ACOG all relevant financial relationships with any commercial interests. The authors, reviewers, and contributors declare that neither they nor any business associate nor any member of their immediate families has financial interest or other relationships with any manufacturer of products or any providers of services discussed in this program. Any conflicts have been resolved through group and outside review of all content.

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